“Our souls reach out for what’s nourishing.” An Interview with Howard Mansfield

In “Waiting (to Go Home),” Howard Mansfield composes portraits of the nursing homes that confine his parents in their “Godot-like absurdities” and the hospitals that function as “disassembly line[s].” Mansfield is the author of six books about preservation and history, including “In the Memory House” and “The Same Ax, Twice.” His most recent book is “Turn and Jump: How Time and Place Fell Apart” (Down East, 2010). Interview by Chad Vogler.

***

When did you begin to feel the need to write about medical establishments?

I have been writing about architecture and preservation for 30 years. I’m interested in the qualities that make us feel at home. My forthcoming book, “Dwelling in Possibility” (Down East 2013), is a search for the soul of shelter. So I was already thinking about this when my mother had to go to a nursing home.

Can you say a little about the phrase “soul of shelter”?

I usually explain this by asking people to think about when they were looking for a house or an apartment. House hunting is a matter of numbers and intuition. The numbers weigh heavily on us—what we can afford, the size of the house, the reputation of the school district. But if we are to be happy in our new home, it’s intuition that rules. We know within seconds upon entering a house, if that’s the place for us. We know when a place makes us feel more alive. Our souls reach out for what’s nourishing.

We are tuned into the qualities of dwelling, the feeling of home that some houses have and others lack. We can recognize these elusive qualities, and yet we find it very difficult, if not impossible, to create this feeling in our new houses and in our towns and cities.

The architect Christopher Alexander calls this animating spirit “the quality without a name”: “The search which we make for this quality, in our own lives, is the central search of any person, and the crux of any individual person’s story,” Alexander writes. “It is the search for those moments and situations when we are most alive.”

“Dwelling in Possibility” is a search for that quality.

Although you visit your parents in two different nursing homes, your essay dwells more often on the inevitability of decay than on your familial relationships. Why?

I’m trying to be as invisible as possible, to report and not invade, if that is possible. I never intended that the essay be about my parents, except as a way of giving me the right to tell the story, to pay attention to the suffering all around me. I know that many other essays in the collection are about how sickness and grief play out in a family. That wasn’t my intent.

One of my models for this sort of essay is Walter Benjamin’s“Berlin Childhood Around 1900.” Benjamin is writing about his childhood, yes, but he’s really after a psychological portrait of a way of life. I can’t say that I rose to that level, but that’s the inspiration.

You often compare the nursing home to the setting of a Samuel Beckett play. The parallel seems to suggest that these institutions partly create the conditions they claim to mitigate.

Hospitals and nursing homes are awful, soul-denying, non-places. They are “the machine arrayed against us,” as I said in my essay. As I read through “At the End of Life,”this theme comes up repeatedly. The writer Reynolds Price, in “A Whole New Life,” his memoir of fighting a spinal tumor, caught the menace of his hospitalization. He had “a growing sense of being consumed by a single vast live idiot creature concealed throughout this enormous building.” What’s striking about “At the End of Life”is how many medical professionals are also aware that they are also being consumed by this “vast live idiot creature.”

In “Turn and Jump,” you suggest that the standardization of time, which was largely brought about by the railroads, severed a connection between time and locality that had until then been the common way of life. Are nursing homes and hospitals horrifying because they’re outside of our dominant conception of time, or are they a logical conclusion of it?

That’s a tough question. The tyranny of all institutions is that they control time. Everyone is on school time or airport time. We wait and do as we are told. Hospitals are like that, but the stakes are higher. The first thing about hospital time is that we never know how long we will be there. Will one test or “procedure” lead to complications? When will the doctor stop by to sign our papers so we can leave? Will we ever leave?

In the background of this all-enveloping hospital time is the small matter of our well-being. We are in the hospital because of another, more insistent clock: our bodies. In illness we are aware of ticking as if we were a time bomb. Will it go off? Will my heart or lungs fail me? We know that our days are limited, but in the hospital we have to live with that knowledge with each breath. And there as we finally try to listen, we are often too drugged and afraid to understand what our body is trying to tell us.

Late in the essay, your voice becomes quite lyrical—almost utopian—when you contemplate the improvements you would make to the health care system, which mostly involve a closer relationship to the natural world and the home. Do you feel these improvements are possible? How so?

There are doctors and nurses struggling daily to make hospitals more humane, but the whole system is just titanic (with all that word implies). Most doctors are still treating a disease and not a patient. It’s like some work we recently had done in our barnyard. A guy with a backhoe dug a perfect hole, all neatly squared off. But all around that hole the machine had smashed the place up. Another successful operation.

How has your experience changed your own plans for end-of-life care, especially as it relates to nursing homes?

Like most writers I don’t institutionalize well. None of us knows how we’ll age, of course, and what pain and illness may await. I can only hope that I’ll have the courage to let go, and that I can do that at home, or in some place that is open to the day.

***

Chad Vogler is an editorial assistant at Creative Nonfiction and a graduate of the University of Pittsburgh’s MFA program in poetry.

"An impressive, meaningful, and often courageous chorus of voices tackling a once-taboo subject with dignity..."

-- PUBLISHERS WEEKLY

"Truly gripping narratives that illuminate a hard truth about death in our culture: it is always so complicated, so much thornier than we think. ... [The] authors, and editor Lee Gutkind, deserve credit for being unsparingly honest about doctoring, about decision-making, about their own ambivalent emotions. They have a lot to teach us."